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Am J Med. 2013 Sep;126(9 Suppl 1):S28-37. doi: 10.1016/j.amjmed.2013.06.011.

Intensifying insulin therapy: what options are available to patients with type 2 diabetes?

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University of Miami Miller School of Medicine, Miami, Fla 33157, USA.


The progressive nature of type 2 diabetes (T2D) requires practitioners to periodically evaluate patients and intensify therapy when glycemic targets become unattainable with their current treatment regimen. Traditional first- and second-line antidiabetic agents such as metformin and the sulfonylureas do not prevent the characteristic decline in beta-cell function associated with T2D; insulin replacement therapy can therefore quickly become a necessity in some patients. Basal insulin initiation provides an excellent platform to which rapid-acting prandial insulin doses can easily be added, potentially in a stepwise manner, as disease progresses. Premix insulin regimens are another effective intensification option following basal insulin initiation, but are most effective in insulin-naïve patients. The use of insulin in combination with modern T2D agents, such as the incretin-based therapies, has the potential to improve glycemic control while limiting insulin-associated weight gain and hypoglycemia. Further clinical data and approval are required before practitioners can fully endorse this novel approach.


Basal insulin intensification; Basal plus insulin therapy; Basal-bolus therapy; hypoglycemia

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